Various surgical devices, including retractors, have been used for many years for lifting, holding and/or spreading body parts and surgical incisions. Known retractors, including the RULTRACT® surgical retractor described in, e.g., U.S. Pat. No. 5,964,699, are configured for lifting primarily, and if a surgical incision requires spreading as well as lifting, it has been necessary to use a separate surgical spreader device and/or one or more additional retractor. As will be readily appreciated, the more devices required to provide access to a patient's body through a surgical incision, the more complicated the procedure and the more likely problems will occur. The surgical procedure may become more complicated, for example, because the various retractor parts must by mounted in proper sequence during the course of the surgical procedure, thus extending the time required to complete the procedure. The surgical procedure may be more likely to encounter problems, e.g., in mounting the various devices, due to prolonging of the surgical procedure, making access to the incision site more difficult, and/or increasing the chances of contamination from the equipment. These potential problems are exacerbated when the patient is a pediatric patient, both due to the small size of the patient and due to the relative weakness of the patient, which may become more significant as the procedure is extended time-wise.
The incidence of re-operative median sternotomy in pediatric congenital patient population is rising. During re-sternotomy, catastrophic hemorrhage remains a dreaded complication. Anterior sternal retraction allows division of adhesions between the sternum and mediastinal structures under direct vision prior to re-sternotomy with a standard reciprocating saw. The overall mortality for redo cardiac procedures is almost 3× higher compared with first time cardiac procedures. The increased risk of redo procedure is partly related to the complications of re-sternotomy which include severe hemorrhage requiring cardiopulmonary bypass and sternal fractures. Factors associated with an increased risk of re-sternotomy include enlarged heart chamber or vessel, history of mediastinitis or sternal osteomyelitis, patent grafts and recent previous operation (<<5 years).
Thus, there has been an ongoing need for an improved surgical retractor that can combine functions, particularly for use with pediatric patients, and more specially for re-sternotomy.